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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ......................................................... Permit No. 7C - PSV <br /> ............................................. <br /> (Complete In Triplicate) ..................... <br /> This Permit Expires O Year From Date IssuedDate issued ........ <br /> :. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to consfruct and install the work herein <br /> described. This application Is made I�njlmpliance with C my OrdinanceNo. 549 and existing Rules and Regulations! <br /> JOB ADDRESS/LOCAT N ... ?..�f.�/...,�.....{,—�.p�..�./�... ................................... <br /> ..................CENSUS TRACT .......................... <br /> Owner's. Name ...... ... C. ... ............... .. Phone .................................... <br /> Address . off. Qo Q:' . ...............`............-••--....... City ., .. ..... ... .......................................... <br /> Contractor's Name .. <br /> .......... .- •. ........ ..........................................License # 2-7Z 2. Phone�� <br /> Installation will serve: Residence OApartment House Commercial)]Trailer Court El <br /> Number of living units:.... / Motel ❑Other............................................ <br /> /...._ Number of bedrooms ......Garbage Grinder ............ Lot Size . .................. <br /> Water Supply: Public System and name ,................................._...................._.•....-...........................................Private, <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Q Peat(j Sandy Loam 0 day Loam ❑ <br /> Hardpan Q Adobe Fill Materlal ............If yes,type............... ............ <br /> !Plot plan, showing size of lot, location of system In relation to wells, buildings, etG must be placed on reverse side.) <br /> NEW INSTALLATION: IN* septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> �'� `g 9 -•............. Lt uid Depth ._..:..............9Q <br /> PACKAGE TREATMENT [ ] SEPTIC TANK�� - -�--a S�1z,�e.!�..__..�....�..._..... 9 p <br /> Ca aci T P,Y . Moterlal. �...... No. Compartments <br /> Capacity/019P�/ �P.... YPe ... . f .... �Q ..... ...........j <br /> Distance to nearest: Well. ,/da.. ..._._....Foundation Prop. Line <br /> -. ..... ........... p. .....a...........6 <br /> If <br /> : .... Length of each line.��.�. �`.'.�19. Total Length �d <br /> ;,EACHING LINE [+�No. of Lines ---- --------•-... ..,.._d..................m <br /> 'D' Box .../..... Type Filter Material �Depth Filter Material ...... ............................... <br /> Or <br /> - „ Distance to nearest: Well ..�!�� .�....... Foundation ..cgs.............. Property Line ........................r <br /> SEEPAGE PIT [� Depth .01 .......... Diameter •� . <br /> / ........ ....... Number ............................ Rock Filled Yes �°' No � <br /> Water Table Depth ....... A04�...... ...............---Rock Size .. .�?�:�..........---•--. <br /> Distance to nearest: Well ----/,;5. .......................Foundation k.0.......... Prop. Line .;E.............. <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ....................!............I 7C <br /> SepticTank (Specify Requirements) .......:..........................................................--•--...................•••.............._. •......._..._................. <br /> ..... ........ ---�•............... <br /> I]+sposal Field (S ci Requirements) ............................•....__.......... ....._......--•--._......... ... ..--. <br /> . •-••-----•............................................. : <br /> . . -----------I............................................... .................................. ..................................................................................................... <br /> --------"............................................................................................._............................................................................................. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be dons In accordance with Sass Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner Of Iicen- <br /> sed agents signature certifies the following- <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to beeoreyo-subi ct to W man' Compensation laws of California." <br /> -anee ��J.. . ........I.,.... ..............21..--••................... Owner <br /> S � ..,GaL/./ J . Jitle ............. .......................................................... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..- f DATE . .. ... .. ...... ........:.._...,... <br /> BUILDING PERMIT ISSUED DATE,- ........................................ <br /> 1 <br /> ...... ... .................................. <br /> ADDITIONAL COMMENTS --.--. ' <br /> ................................................... ..............................I....... --...................................... ....... .....--............. .-.-............ <br /> ..... <br /> .. <br /> Final Inspection by: .. .......&�. !......... . .... .............. Date .�� ..... .. ......... <br /> ER 13 24 1-611 3tay. 5iSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />